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J Reconstr Microsurg 2024; 40(03): 171-176
DOI: 10.1055/a-2087-2752
Original Article

Skull and Scalp En-Bloc Harvest Protects Calvarial Perfusion: A Cadaveric Study

Christopher D. Lopez
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Alisa O. Girard
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Isabel V. Lake
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Visakha Suresh 
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Hossam Abdou
2   R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
,
Jonathan J. Morrison
2   R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
,
Robin Yang
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Chad R. Gordon
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Richard J. Redett
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations Funding None.
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Abstract

Background Calvarial defects are severe injuries that can result from a wide array of etiologies. Reconstructive modalities for these clinical challenges include autologous bone grafting or cranioplasty with biocompatible alloplastic materials. Unfortunately, both approaches are limited by factors such as donor site morbidly, tissue availability, and infection. Calvarial transplantation offers the potential opportunity to address skull defect form and functional needs by replacing “like-with-like” tissue but remains poorly investigated.

Methods Three adult human cadavers underwent circumferential dissection and osteotomy to raise the entire scalp and skull en-bloc. The vascular pedicles of the scalp were assessed for patency and perfused with color dye, iohexol contrast agent for computed tomography (CT) angiography, and indocyanine green for SPY-Portable Handheld Imager assessment of perfusion to the skull.

Results Gross changes were appreciated to the scalp with color dye, but not to bone. CT angiography and SPY-Portable Handheld Imager assessment confirmed perfusion from the vessels of the scalp to the skull beyond midline.

Conclusion Calvarial transplantation may be a technically viable option for skull defect reconstruction that requires vascularized composite tissues (bone and soft tissue) for optimal outcomes.

Keywords

perfusion study - skull transplant - scalp perfusion


Publication History

Received: 20 November 2022

Accepted: 02 May 2023

Accepted Manuscript online:
05 May 2023

Article published online:
10 July 2023

© 2023. Thieme. All rights reserved.

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